To understand a message, we need information to be written at a level that does not exceed your reading ability. But what happens if the context you are trying to process that information in is one of high stress?
Let’s imagine that Bob, a 50-year-old man is sitting at home watching television. Bob's waiting for his wife, Barbara, to bring him his dinner.
Then he hears a crash. He rushes to the kitchen to find Barbara sprawled out on the floor having tripped over Bob’s suitcase.
Between shouting at Bob for leaving his bloody suitcase in the way, Barbara cries out in pain. ‘What shall I do?’ Asks Bob.
Barbara’s leg is at a weird angle and she looks kind of freaky. Bob thinks, I know, I’ll ask Google, the magic man in the computer. He knows everything.
Bob types into his phone what should you do when your wife has a fall?
He’s presented with a list of sites on what to do when your wife falls out of love with you. Bob bookmarks a couple of these for later use and tries another search for what to do if someone falls?
The first result provides a clear bulleted list of what to do if you witness a fall.
This page is nice and readable. It has a Flesch-Kincaid level of 6.1, well within the suggested reading level for the general public.
While Bob is usually quite good at reading, the air of panic makes this easily written text about the right level for him to engage with.
He follows the simple instruction to leave Barbara where she is and pop a blanket over her. Then he goes to the next room to call an ambulance.
Perhaps he should have called earlier but he couldn’t really think as, it turns out, Barbara can shout quite loudly.
Bob was lucky. The information he was presented with was easy to understand. But, what if this wasn’t the case?
In this article we’ll look at:
- some of the challenges of trying to process risk communication information in a high stress situation
- the readability of risk communication information
- some ideas of how the readability of risk information might be improved.
Challenges and costs of reading in a crisis
For many of us, reading is something we do without even thinking. But, reading in a crisis and in a high stress situation, can make reading more challenging. Especially, when the information to be processed is critical, and the consequences hazardous.
Stress affects the body in different ways. A key response is the release of chemicals, such as cortisol, that changes in how the body responds to threat.
These changes include increased heart rate, higher blood sugar and increased arousal. Many of the symptoms of chronic stress are illustrated in thinking.
These include a short attention span, poor concentration and inability to focus, and problems with memory. It is easy to imagine how these symptoms could impair reading ability.
The context of seeking risk information compounds the need for this information to be written at a level well within the reading ability of the intended reader.
In a crisis situation, how clearly a message is understood and the subsequent accuracy by which guidance is followed can either improve the situation or make it a whole lot worse.
If we consider Bob’s wife’s fall. If Bob hadn't accurately followed the advice, he may have tried to get Barbara up off the floor. Potentially adding to the existing damage caused by the fall. In a crisis situation, the potential costs of misunderstanding of information can be significant.
If risk communication information is too difficult to understand then:
- This might be an obstacle to obtaining necessary health information required to know what health seeking behaviours to engage in, or;
- Especially given the symptoms of stress on thinking, when trying to obtain health information there is a danger that people could misunderstand the message being communicated. Leading them to respond in a way that was unsafe
Evidence on readability of risk communications
One context which is associated with crisis and stress is the hospital emergency department.
A study was conducted to explore the readability of patient materials provided in emergency departments.
The study involved a systematic review of published studies assessing emergency department (ED) patients’ health literacy, the readability of ED patient materials, and the relationship between health literacy and ED outcomes.
The researchers note that ED patients and their caregivers are required to process complex information and quickly make critical decisions.
They highlight that the extent to which patients can process and understand health information may fundamentally impact both patient-doctor communication and the ability of the patient to act on information provided during their time in ED.
The study reported that, overall, health literacy skills were calculated at or below the eighth grade level for approximately 40% of ED patients. Yet, the study revealed the readability of ED patient materials to be at or above ninth grade level.
Further, the study revealed that those studies conducted on adults aged 65 years and older reported that those with lower health literacy, that is, a lower ability to process and understand health information and take action based on that information, were more likely to use the ED and experience higher ED costs.
What about when the crisis is an international one?
Consider the outbreak of Ebola in 2014, an international public health emergency. A disease with no anti-viral treatment or vaccine, the behavior of the public to control the spreading of the disease through recognition of symptoms and health-care seeking behaviors was paramount.
But was risk information communicated in an easy to understand way?
A study was conducted to assess the readability of Ebola Information on websites of public health agencies in the US, UK, Canada, Australia, and Europe.
The study centred on a selection of major public health agency websites, assessing them via a range of readability formula including Flesch Reading Ease and Gunning-Fog Index.
Agencies included the US Centers for Disease Prevention and Control and the World Health Organization.
Findings revealed that the information communicated would be difficult for the public to understand given that readability levels were above the anticipated reading level of the general public.
As the researchers conclude, “poor readability might prevent or delay adoption of appropriate health-seeking behaviors, prolong ineffective self-care strategies, and perpetuate stigmatizing attitudes toward Ebola”.
How can the readability of risk information be improved?
Poor readability of risk communication information has high costs. So, how the readability of this information be improved?
One way of making risk communication more easily understandable includes involving intended users in the design of the communications and then testing and revising messages with the intended users.
Having worked with people responsible for communicating health messages to the public, I’m familiar with wanting to engage intended users of information. But, time constraints often mean this intention often doesn’t make it into practice.
Given the evidence of poor readability of communication, perhaps it’s time for protocols on user engagement to be created and enforced.
And what about when we are talking about crisis on a wide scale?
Researchers looking at the communication of information during crisis situations have created methods to summarising situational and topical information during a crisis.
In crisis situations, short messaging social media services such as Twitter are used to share and source information. However, quantities of tweets are high and the information is not always easily readable.
To try and improve the readability and overall quality of information available during a crisis, researchers have created a two-stage framework.
The framework first extracts a set of important tweets on the issue, for example, an earthquake in Pakistan. Then, the framework applies algorithms to re-write these tweets into informative summaries.
There is an algorithm to create summaries for situational analysis. Which is the kind of information required by humanitarian agencies who need to understand the situation and the severity of the crisis.
A further algorithm allows identification of sub-topics and generates short informative summaries for each topic. The formula includes assessment of readability with the aim of generating more readable and informative summaries.
There are, of course, challenges to communicating risk related information in an easy to read way.
The information can be complex but it needs to be communicated without jargon. Information needs to be specific, yet with more detail often comes more words and increased use of complex words.
While there are many reasons why risk related information may not be communicated in an easy to read way, these can never outweigh the costs of not making this information readable to those who need it most.